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Left ventricular free wall rupture following mitral valve replacement
K Yoshida1, H Ohshima, F Murakami
1Division of Cardiovascular Surgery, Cardiovascular Center, Aichi Prefectural Owari Hospital, 2135 Kariyasuka, Yamato-cho, Ichino-miya, Aichi 491-0934.
Abstract:
During a 10-year period, 110 patients underwent mitral valve replacement (MVR). We experienced three left ventricular ruptures among these patients. Two had a type I immediate rupture, and one had a type III delayed rupture. Two patients (type I, III) survived after repair of the rupture. It was possible to control bleeding by manual compression with oxidized cellulose, collagen mat and fibrin glue with or without external mattress sutures. Following the repair, an intra-aortic balloon pump and sedative agents were used in both patients. In the other patient with a type I early rupture, control of bleeding was attempted by external direct suture using Teflon felt. The bleeding was controlled by this repair and the use of a left ventricular assist device, but the patient died of a brain infarction 5 days after the operation. The manual compression technique using oxidized cellulose, collagen mat and fibrin glue may be useful for minor lacerations, and for reinforcing repairs. The intra-aortic balloon pump and continuous sedation are useful for unloading the ventricle and reducing the tension on repairs.
Insights
Left ventricular rupture during mitral valve replacement is rare but serious. Prompt repair with manual compression or sutures, alongside supportive measures like balloon pumps, can improve survival rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Ventricular Rupture Management
Background:
- Mitral valve replacement (MVR) is a common cardiac procedure.
- Left ventricular rupture is a rare but life-threatening complication following MVR.
- Understanding rupture types and effective management strategies is crucial for improving patient outcomes.
Observation:
- Over a decade, 110 patients underwent MVR, with three instances of left ventricular rupture.
- Ruptures included two immediate Type I and one delayed Type III.
- Two patients with Type I and Type III ruptures survived after surgical repair.
Findings:
- Successful bleeding control was achieved using manual compression with oxidized cellulose, collagen mat, and fibrin glue, with or without sutures.
- One patient with Type I rupture, treated with external sutures and a left ventricular assist device, unfortunately died from brain infarction.
- Supportive care, including intra-aortic balloon pump and sedation, aided ventricular unloading and reduced tension on repairs.
Implications:
- Manual compression techniques with biomaterials can be effective for minor lacerations and reinforcing repairs.
- Intra-aortic balloon pumps and sedation are valuable adjuncts for managing ventricular stress post-rupture repair.
- These findings highlight the importance of tailored surgical and supportive interventions for left ventricular rupture after MVR.